Radiation Oncology/Endometrium/Guidelines

Endometrial Cancer Guidelines

• SFGO: Societe Francaise d'Oncologie Gynecologique
  • 2011 PMID 21697683 -- "Clinical practice guidelines for the management of patients with endometrial cancer in france: recommendations of the Institut National du Cancer and the Société Française d'Oncologie Gynécologique" (Querleu D, Int J Gynecol Cancer. 2011 Jul;21(5):945-50.)

• Stage I - Low risk (IAG1-G2)
  • Surgery: TH/BSO, PLND not recommended
  • RT: HDR VB if myometrial invasion; EBRT not recommended
  • Chemo: not recommended
• Stage I - Intermediate risk (IAG3, IBG1-G2)
  • Surgery: TH/BSO, PLND not recommended but can be considered IBG2 or IAG3 with myometrial involvement
  • RT: HDR VB; EBRT not recommended
  • Chemo: not recommended
• Stage I - High risk (IBG3, IA-B type 2, I with LVI+)
  • Surgery: TH/BSO, P/PALND recommended
  • RT: pelvic EBRT; additional VBT can be considered
  • Chemo: not recommended
• Stage I - Clear cell or papillary serous
  • Surgery: TH/BSO, P/PALND, infracolic omentectomy, periotoneal cytology, biopsy
  • RT: pelvic EBRT; additional VBT can be considered
  • Chemo: can be considered
• Stage I - Carcinosarcoma
  • Surgery: TH/BSO, P/PALND
  • RT: pelvic EBRT; additional VBT can be considered
  • Chemo: can be considered
• Stage II
  • Surgery: Hysterectomy, +/- vaginectomy, PLND,
    • For type I: consider PLND
    • For type II: P/PALND, infracolic omentectomy, peritoneal cytology, biopsy
  • RT: EBRT with HDR VBT; if large volume cervix disease, can consider preop RT
  • Chemo: Can be considered for type 2
• Stage IIIA
  • Surgery: TH/BSO, infragastric omentectomy, P/PALND, peritoneal cytology
  • RT
    • Serosa alone: pelvic EBT with HDR VBT
    • Cervix affected: HDR VBT
  • Chemo: if adnexa affected
• Stage IIIB
  • RT as sole therapy is the main option (pelvic EBRT with uterine/vaginal BT)
  • PLND as staging can be considered
  • Chemo: concomitant chemotherapy can be considered
  • Surgery: can be considered if partial response to RT
• Stage IIIC (pathologic)
  • Surgery: immediate or delayed PALND
  • RT: pelvic RT (IIIC1) or pelvic/para-aortic RT (IIIC2) with HDR VBT
  • Chemo: adjuvant CT must be discussed
• Stage IIIC1 (imaging)
  • Surgery: TH/BSO, PPALND
  • RT: pelvic EBRT, with VBT
  • Chemo: adjuvant CT may be discussed
• Stage IIIC2 (imaging)
  • Pelvic and para-aortic RT, followed by lymphatic boost, and uterine/vaginal BT
  • If conditions favorable for surgery, TH/BSO and PPALND recommended, followed by pelvic EBRT and VBT
  • Chemo: must be discussed
• Stage IV (Bowel/bladder)
  • Pelvic EBRT with BT
  • Chemo: can be considered
  • If RT fails, pelvic exenteration can be considered
• Stage IV (Distant mets, including intra-abdominal or inguinal nodes)
  • Cytoreductive surgery only for operable peritoneal carcinosis
  • Chemo: recommended
  • Hormone therapy: recommended for ER+
  • RT: pelvic EBRT recommended to primary tumor
  • If inguinal LN, additional lymphadenectomy recommended

Brachytherapy

• ABS: American Brachytherapy Society
  • 2012: Vaginal cuff PMID 22265439 -- "American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy."
    • Note: also includes indications for vaginal cuff irradiation for cervical cancer